[Challenges in accessing treatment for chronic hepatitis B in Madagascar : A qualitative study of caregivers and patients]. / Enjeux et difficultés de l'accès aux traitements pour la prise en charge de l'hépatite B chronique à Madagascar : étude qualitative auprès des soignants et personnes atteintes.

OBJECTIVES: Madagascar faces many difficulties in accessing diagnosis and treatment of hepatitis B. The prevalence of chronic hepatitis B infection is estimated at 6.9%. The costs associated with screening and treatment are high and not easily accessible. This article proposes a reflection on the challenges and difficulties of access to diagnosis and treatment for patients with chronic hepatitis B. METHOD: The "Neo Vac" study aimed to document the life paths of people living with chronic hepatitis B, their difficulties and their perceptions of HBV. Twenty-three semi-structured interviews were conducted in 2019 in Antananarivo with patients and gastroenterologists. RESULTS: The study describes the numerous obstacles that mark the therapeutic pathways of chronic HBV patients. The first result indicates lack of knowledge of the disease by chronic HBV patients and the varied circumstances in which the disease is discovered. None of the persons interviewed had been screened on their own initiative, the screening having taken place during prenatal consultations or emergency hospitalizations or during a morbidity episode. The care pathway was characterized by doubt and anxiety due to lack of knowledge about the possible disease outcome and concern about the costs of care. DISCUSSION: Little known by the population and health professionals, hepatitis B is rarely the subject of voluntary screening and is most often detected during an apparently unrelated health event. The exorbitant cost of treatment for patients, the cost of medical analyses and secondary costs, and the unavailability of follow-up tests outside the capital constitute barriers to access to care that are insurmountable for the majority of the Malagasy population. CONCLUSIONS: This first qualitative study on the experiences of HBV-infected persons in terms of access to care and treatment in Madagascar underlines the extent to which access to treatment remains limited, due to the absence of a national policy for the prevention, screening and management of hepatitis B, which remains a highly neglected and unrecognized disease in Madagascar as well as internationally.

Increased recurrence rates of hepatocellular carcinoma after DAA therapy in a hepatitis C-infected Egyptian cohort: A comparative analysis.

In Egypt, hepatocellular carcinoma (HCC) is the most common form of cancer and direct-acting antivirals (DAA) are administered on a large scale to patients with chronic HCV infection to reduce the risk. In this unique setting, we aimed to determine the association of DAA exposure with early-phase HCC recurrence in patients with a history of HCV-related liver cancer. This was a prospective cohort study of an HCV-infected population from one Egyptian specialized HCC management centre starting from the time of successful HCC intervention. The incidence rates of HCC recurrence between DAA-exposed and nonexposed patients were compared, starting from date of HCC complete radiological response and censoring after 2 years. DAA exposure was treated as time varying. Two Poisson regressions models were used to control for potential differences in the exposed and nonexposed group; multivariable adjustment and balancing using inverse probability of treatment weighting (IPTW). We included 116 patients: 53 treated with DAAs and 63 not treated with DAAs. There was 37.7% and 25.4% recurrence in each group after a median of 16.0 and 23.0 months of follow-up, respectively. Poisson regression using IPTW demonstrated an association between DAAs and HCC recurrence with an incidence rate ratio of 3.83 (95% CI: 2.02-7.25), which was similar in the multivariable-adjusted model and various sensitivity analyses. These results add important evidence towards the possible role of DAAs in HCC recurrence and stress the need for further mechanistic studies and clinical trials to accurately confirm this role and to identify patient characteristics that may be associated with this event.

Temperature-induced A-B intersite charge transfer in an A-site-ordered LaCu(3)Fe(4)O(12) perovskite.

Changes of valence states in transition-metal oxides often cause significant changes in their structural and physical properties. Chemical doping is the conventional way of modulating these valence states. In ABO(3) perovskite and/or perovskite-like oxides, chemical doping at the A site can introduce holes or electrons at the B site, giving rise to exotic physical properties like high-transition-temperature superconductivity and colossal magnetoresistance. When valence-variable transition metals at two different atomic sites are involved simultaneously, we expect to be able to induce charge transfer-and, hence, valence changes-by using a small external stimulus rather than by introducing a doping element. Materials showing this type of charge transfer are very rare, however, and such externally induced valence changes have been observed only under extreme conditions like high pressure. Here we report unusual temperature-induced valence changes at the A and B sites in the A-site-ordered double perovskite LaCu(3)Fe(4)O(12); the underlying intersite charge transfer is accompanied by considerable changes in the material's structural, magnetic and transport properties. When cooled, the compound shows a first-order, reversible transition at 393 K from LaCu(2+)(3)Fe(3.75+)(4)O(12) with Fe(3.75+) ions at the B site to LaCu(3+)(3)Fe(3+)(4)O(12) with rare Cu(3+) ions at the A site. Intersite charge transfer between the A-site Cu and B-site Fe ions leads to paramagnetism-to-antiferromagnetism and metal-to-insulator isostructural phase transitions. What is more interesting in relation to technological applications is that this above-room-temperature transition is associated with a large negative thermal expansion.

Disordered ground state and magnetic field-induced long-range order in an S=3/2 antiferromagnetic honeycomb lattice compound Bi3Mn4O12(NO3).

Bi3Mn4O12(NO3), in which the Mn4+ ions carry S=3/2, is the first honeycomb lattice system that shows no long-range magnetic order. Using neutron scattering, we have determined that short-range antiferromagnetic correlations develop at low temperatures. Applied magnetic fields induce a magnetic transition, in which the short-range order abruptly expands into a long-range order.

HAADF-STEM analysis of layered double perovskite La(2)CuSnO(6) grown epitaxially.

Structural observation of layered double perovskite oxide La(2)CuSnO(6) thin films grown epitaxially on SrTiO(3) is reported by high-angle annular dark-field scanning transmission electron microscopy (HAADF-STEM). Particularly the transition layer at the interface was observed, and the first B site layer at the interface was found to be almost formed by the Cu atomic layer as the random structure, followed by formation of the layered structure. In addition, HAADF-STEM images indicate that the thin film is not single crystalline, but some irregular structures were observed to grow around the interface near atomic steps of the substrate of SrTiO(3). Therefore, the steps largely affect the growth process of the thin film.

Local analysis of the edge dislocation core in BaTiO(3) thin film by STEM-EELS.

The a <100> edge dislocation core formed in an epitaxial BaTiO(3) (BTO) thin film grown on a substrate was investigated by scanning transmission electron microscopy combined with electron energy-loss spectroscopy. Elemental analysis using core-loss spectrum indicates that the atomic ratios of O/Ti and Ba/Ti are decreased at the dislocation core. The near-edge fine structure of the oxygen K-edge recorded from the dislocation core differs slightly from that of relaxed BTO region, which suggests that Ba-O bonding is decreased at the dislocation core. The structure of the dislocation core is discussed using a high-angle annular dark-field image and the electron energy-loss spectroscopy results.

Orbital hybridization and magnetic coupling of the A-site Cu spins in CaCu3B4O12 (B = Ti, Ge, and Sn) perovskites.

X-ray absorption spectroscopy (XAS) spectra near the O K-edge of A-site-ordered perovskite with A-site Cu(2+) (S = (1)/(2)) spins were measured. The spectra of ferromagnetic CaCu(3)Ge(4)O(12) and CaCu(3)Sn(4)O(12) showed hybridization between Cu 3d and O 2p orbitals, but magnetic circular dichroism measurement revealed that the O 2p orbital played a less important role in magnetic interaction. The XAS spectra of antiferromagnetic CaCu(3)Ti(4)O(12), on the other hand, showed strong hybridization of the Cu 3d, Ti 3d, and O 2p orbitals. These results demonstrated that direct exchange interaction of the Cu(2+) spins primarily determined the ferromagnetic ordering of CaCu(3)Ge(4)O(12) and CaCu(3)Sn(4)O(12), whereas the involvement of Ti 3d orbitals induced the antiferromagnetic property in CaCu(3)Ti(4)O(12).

Effects of electron channeling in HAADF-STEM intensity in La2CuSnO6.

Atomic resolution imaging using the high-angle annular dark-field scanning transmission electron microscopy (HAADF-STEM) can be applied to analyze the atomic structures of materials directly. This technique provides incoherent Z-contrast with the atomic number of the constituent elements. In the present work, unique contrasts that make intuitively interpreting the HAADF-STEM image in double perovskite oxide La(2)CuSnO(6) difficult were observed. Multislice simulation confirmed that this occurred as an effect of the channeling process of electrons in combination with the effect of Debye-Waller factors. This was confirmed because in the La(2)CuSnO(6) crystal, two independent Sn atoms and four independent La atoms in the unit cell had different Debye-Waller factors, and the La columns consisted of pairs of columns with a small separation, whereas the Sn atoms were arranged straight. Furthermore, the image contrast was examined by mutislice simulation, and two atomic La columns were separated in a projected plane and appeared as one column contrast using multislice simulation. As a result, the HAADF intensity did not decrease constantly with the increase in column separation, with the exception of a very thin sample, which could be interpreted by the specific change in the electron-channeling process.

Systematic review with meta-analysis: the risk of mother-to-child transmission of hepatitis B virus infection in sub-Saharan Africa.

BACKGROUND: The risk of mother-to-child transmission of hepatitis B virus (HBV) has been quoted as 70-90% among women positive for hepatitis B surface antigen (HBsAg) and e antigen (HBeAg), and 5-30% among HBsAg-positive HBeAg-negative women. These risks are derived from Asia; little is known about sub-Saharan Africa. AIM: To determine the risk of mother-to-child transmission in sub-Saharan Africa, according to maternal HBeAg and type of prophylaxis. METHODS: We searched Medline, Global Health, Embase, African Journals Online and African Index Medicus. We included observational or interventional studies that enrolled infants of HBV-infected women, and that tested for HBsAg or HBV DNA between 3 and 12 months of age. RESULTS: Fifteen articles from 11 African countries were included. Among HBeAg-positive women, the pooled risk was 38.3% (95% CI: 7.0-74.4%) without prophylaxis, which was significantly lower than the lower bound of 70-90% risk in the literature (P = 0.007). Among HBeAg-negative women, the pooled risk was 4.8% (95% CI: 0.1-13.3%) without prophylaxis, which lays within the lower range of the 5-30% risk in Asia. By extrapolating the pooled transmission risks to the number of births to infectious mothers, an estimated 1% of newborns (n = 367 250) are annually infected with HBV at birth in sub-Saharan Africa. CONCLUSIONS: Compared to Asia, the risk of mother-to-child transmission is low in sub-Saharan Africa. However, the annual number of infants perinatally infected with HBV is twice the number of incident paediatric HIV infections in sub-Saharan Africa (n = 190 000). This highlights the importance of preventing mother-to-child transmission of HBV in sub-Saharan Africa, which has been long neglected.

Hepatitis E virus infection and acute-on-chronic liver failure in West Africa: a case-control study from The Gambia.

BACKGROUND: In sub-Saharan Africa, it is unknown whether hepatitis E virus (HEV) infection is a common precipitating event of acute-on-chronic liver failure (ACLF). AIMS: To estimate the prevalence of HEV infection in general population and assess whether HEV is a common trigger of ACLF in cirrhotic patients in The Gambia, West Africa. METHODS: We first conducted an HEV sero-survey in healthy volunteers. We then tested cirrhotic patients with ACLF (cases) and compensated cirrhosis (controls) for anti-HEV IgG as a marker of exposure to HEV, and anti-HEV IgA and HEV RNA as a marker of recent infection. We also described the characteristics and survival of the ACLF cases and controls. RESULTS: In the healthy volunteers (n = 204), 13.7% (95% CI: 9.6-19.2) were positive for anti-HEV IgG, and none had positive HEV viraemia. After adjusting for age and sex, the following were associated with positive anti-HEV IgG: being a Christian, a farmer, drinking water from wells, handling pigs and eating pork. In 40 cases (median age: 45 years, 72.5% male) and 71 controls (39 years, 74.6% male), ≥70% were infected with hepatitis B virus. Although hepatitis B flare and sepsis were important precipitating events of ACLF, none had marker of acute HEV. ACLF cases had high (70.0%) 28-day mortality. CONCLUSIONS: Hepatitis E virus infection is endemic in The Gambia, where both faecal-oral route (contaminated water) and zoonotic transmission (pigs/pork meat) may be important. However, acute HEV was not a common cause of acute-on-chronic liver failure in The Gambia.

Superconducting fluctuations and the pseudogap in the slightly overdoped high- T(c) superconductor TlSr2CaCu2O6.8: high magnetic field NMR studies

From measurements of the 63Cu Knight shift ( K) and the nuclear spin-lattice relaxation rate ( 1/T1) under magnetic fields from zero up to 28 T in the slightly overdoped high- T(c) superconductor TlSr2CaCu2O6.8 ( T(c) = 68 K), we find that the pseudogap behavior, i.e., the reductions of 1/T1T and K above T(c) from the values expected from the normal state at high T, is strongly field dependent and follows a scaling relation. We show that this scaling is consistent with the effects of the Cooper pair density fluctuations. The present finding contrasts sharply with the pseudogap property reported previously in the underdoped regime where no field effect was seen up to 23.2 T. The implications are discussed.

Evaluation of Bifidobacterium breve strain Yakult-fermented soymilk as a probiotic food.

We evaluated the effects of Bifidobacterium breve-fermented soymilk on probiotic function. An administered strain of B. breve strain Yakult was capable of growing in soymilk with no additives as high as 10(9) CFU/ml. During storage of the fermented soymilk at 10 degrees C for 20 days, viable counts of the strain did not change. The growth inhibition of the strain in a bile-containing medium was lessened by the addition of soy protein. In human feeding experiments, the administered B. breve was recovered at a level of over 10(9) CFU/g faeces, accompanied by an increase in the total number of bifidobacteria. These results indicate that fermented soymilk with B. breve strain Yakult could be a novel type of probiotic food.

Food intake increases liver stiffness measurements and hampers reliable values in patients with chronic hepatitis B and healthy controls: the PROLIFICA experience in The Gambia.

BACKGROUND: By increasing the hepatic blood circulation, food intake has been suggested to increase liver stiffness measurement (LSM) values in HCV-infected patients. AIM: To investigate prospectively the effects of food intake on LSM in hepatitis B virus (HBV)-infected patients and healthy controls. METHODS: In The Gambia, patients included in the PROLIFICA project are screened for HBV at the community level and then invited for fasting assessment including LSM. Between April 2012 and October 2012, each day, the first five participants were invited to participate in this study. After the initial examination, a standardised 850 Kcal breakfast was provided. Effect of food intake was assessed by examining mean difference of LSM, IQR and IQR/LSM at T0 (fasting LSM1), T30min (LSM2) and T120min (LSM3) respectively. RESULTS: A total of 209 subjects were enrolled in this study (133 were HBV positive, 76 healthy controls). Unreliable measurements occurred more frequently after food intake (5%, 24% and 18% at T0, T30min and T120min respectively). In both groups, median LSM2 was significantly higher than LSM1 [6.2 (IQR: 5.4, 7.9)] vs. 4.9 (4.2, 6.2), P < 0.0001. LSM3 was still higher than the baseline, but lower than LSM2. In multivariable analysis, no factor modified the effect of breakfast on LSM. In a subgroup of patients having liver biopsies, we confirmed that food intake can overestimate liver fibrosis. CONCLUSIONS: Food intake significantly increases liver stiffness measurement and its IQR values in patients with chronic hepatitis B as well as healthy individuals; and also the number of unreliable liver stiffness measurement values.